杨玉萍教授治疗吉非替尼相关皮肤瘙痒症验案  

Case study of Professor YANG Yuping in the treatment of gefitinib-related pruritus

作　　者：张云霞 程逸凡 杨玉萍[2] ZHANG Yunxia;CHENG Yifan;YANG Yuping

机构地区：[1]江西中医药大学,江西南昌330004 [2]江西中医药大学附属医院,江西南昌330006

出　　处：《中医临床研究》2022年第36期55-56,共2页Clinical Journal Of Chinese Medicine

基　　金：江西省肺系疾病临床研究中心(20181BCG42005)。

摘　　要：吉非替尼为表皮生长因子受体(Epidermal Growth Factor Receptor,EGFR)酪氨酸激酶抑制剂,能够通过阻断肿瘤细胞内EGFR的激活和信号传导而起到抗肿瘤的作用,因此,该药已广泛应用于肿瘤的治疗,尤其在非小细胞肺癌的治疗中能有效延长患者的生存期。临床发现,该药治疗肺癌过程中,常见不良反应以皮肤毒性发病率为最高,表现为痤疮样、脓疱样皮疹,以及周身皮肤干燥、瘙痒、皲裂,严重影响患者的生活质量甚者中断靶向治疗,从而影响治疗效果。目前针对吉非替尼相关皮肤瘙痒的药物治疗以抗组胺H1和H2受体拮抗剂、糖皮质激素、免疫调节及局部外用治疗为主,但常因出现不良反应无法长期应用,治疗间断后,瘙痒迅速复发。杨玉萍教授从医30余年,对吉非替尼相关性皮肤瘙痒有其独到的见解。杨教授认为该病是由吉非替尼“热性之品”深入血分,又化燥生风而发病,皮损在外,而本质在内,宜从内治。现论述吉非替尼相关皮肤瘙痒症的病因病机、临床症状,对杨玉萍在辨证论治的基础上应用犀角地黄汤、清营汤等清热凉血药治疗吉非替尼相关皮肤瘙痒症的经验进行总结,并举案以资验证。Gefitinib is an epidermal growth factor receptor(EGFR)tyrosine kinase inhibitor,which can play an anti-tumor role by blocking the activation and signaling of EGFR in tumor cells.Therefore,Gefitinib has been widely used in the treatment of tumors,especially in the treatment of non-small cell lung cancer,and can effectively prolong the survival of patients.Clinically,in the treatment of lung cancer with this drug,the incidence of dermatotoxicity is the highest,which is manifested as acne-like and impetigo-like rashes,as well as dry,itchy and chapped skin all over the body,seriously affecting the quality of life of patients,and even interrupting the targeted therapy and affecting the therapeutic effect.At present,the drug treatment for gefitinib-related pruritus is mainly based on antihistamine H1 and H2 receptor antagonists,glucocorticoids,immune regulation and local topical treatment.However,it is often unable to be applied for a long time due to adverse reactions,and the pruritus rapidly relapsed after interrupted treatment.Professor YANG Yuping has been a doctor for more than 30 years,and has her unique insights on gefitinib-related pruritus.Professor YANG believes that the disease is caused by gefitinib“heat property”which goes deep into the blood and turns dryness into wind,and it should be treated within.This article discusses the etiology,pathogenesis and clinical symptoms of gefitinib-related pruritus,summarizes the experience of YANG Yuping in treating gefitinib-related pruritus with the Xijiao Dihuang decoction(犀角地黄汤),the Qingying decoction(清营汤)and other heat-clearing and blood-cooling drugs on the basis of syndrome differentiation and treatment,and cites cases for verification.

关 键 词：吉非替尼相关皮肤瘙痒症 清热凉血药 临证经验 

分 类 号：R758.31[医药卫生—皮肤病学与性病学]